Impact of Positive Surgical Margins After Partial Nephrectomy

Abstract Background The impact of positive surgical margins (PSMs) after partial nephrectomy (PN) is controversial. Objective To evaluate the risk factors for a PSM and its impact on overall survival. Design, setting, and participants This is a retrospective study of 388 patients were submitted to PN between November 2005 and December 2016 in a single centre. Two groups were created: PSM and negative surgical margin (NSM) after PN. A p value of Outcome measurements and statistical analysis Relationships with outcome were assessed using univariable and multivariable tests and log-rank analysis. Results and limitations The PSM rate was 3.8% (N = 16). The mean age at the time of surgery (PSM group: 64.1 ± 11.3 vs NSM group: 61.8 ± 12.8 yr, p =  0.5) and the mean radiological tumour size (4.0 ± 1.5 vs 3.4 ± 1.8 cm, p =  0.2) were similar. Lesion location (p =  0.3), surgical approach (p =  0.4), warm ischaemia time (p =  0.9), and surgery time (p =  0.06) had no association with PSM. However, higher surgeon experience was associated with a lower PSM incidence (2.6% if ≥30 PNs vs 9.6% if Conclusions PSMs were mainly associated with high-risk pathological tumour (p =  0.05) and low-volume surgeon experience. Recurrence rate and need for total nephrectomy were higher in that group, but no impact on survival was noticed. Patient summary The impact of positive surgical margins (PSMs) after partial nephrectomy is a matter of debate. In this study, we found that PSMs were mainly associated with aggressive disease and low surgeon experience.